Expert recommendations for the laboratory diagnosis of MPS VI

Mucopolysaccharidosis VI (MPS VI) is a lysosomal storage disease caused by a deficiency of N-acetylgalactosamine 4-sulfatase (arylsulfatase B, ASB). This enzyme is required for the degradation of dermatan sulfate. In its absence, dermatan sulfate accumulates in cells and is excreted in large quantities in urine. Specific therapeutic intervention is available; however, accurate and timely diagnosis is crucial for maximal benefit. To better understand the current practices for diagnosis and to establish diagnostic guidelines, an international MPS VI laboratory diagnostics scientific summit was held in February of 2011 in Miami, Florida. The various steps in the diagnosis of MPS VI were discussed including urinary glycosaminoglycan (uGAG) analysis, enzyme activity analysis, and molecular analysis. The following conclusions were reached. Dilute urine samples pose a significant problem for uGAG analysis and MPS VI patients can be missed by quantitative uGAG testing alone as dermatan sulfate may not always be excreted in large quantities. Enzyme activity analysis is universally acknowledged as a key component of diagnosis; however, several caveats must be considered and the appropriate use of reference enzymes is essential. Molecular analysis supports enzyme activity test results and is essential for carrier testing, subsequent genetic counseling, and prenatal testing. Overall the expert panel recommends caution in the use of uGAG screening alone to rule out or confirm the diagnosis of MPS VI and acknowledges enzyme activity analysis as a critical component of diagnosis. Measurement of another sulfatase enzyme to exclude multiple sulfatase deficiency was recommended prior to the initiation of therapy. When feasible, the use of molecular testing as part of the diagnosis is encouraged. A diagnostic algorithm for MPS VI is provided.

Coincidence of two novel arylsulfatase A alleles and mutation 459+1G>A within a family with metachromatic leukodystrophy: molecular basis of phenotypic heterogeneity

In a family with three siblings, one developed classical late infantile metachromatic leukodystrophy (MLD), fatal at age 5 years, with deficient arylsulfatase A (ARSA) activity and increased galactosylsulfatide (GS) excretion. The two other siblings, apparently healthy at 12(1/2) and 15 years, respectively, and their father, apparently healthy as well, presented ARSA and GS values within the range of MLD patients. Mutation screening and sequence analysis disclosed the involvement of three different ARSA mutations being the molecular basis of intrafamilial phenotypic heterogeneity. The late infantile patient inherited from his mother the frequent 0-type mutation 459+1G>A, and from his father a novel, single basepair microdeletion of guanine at nucleotide 7 in exon 1 (7delG). The two clinically unaffected siblings carried the maternal mutation 459+1G>A and, on their paternal allele, a novel cytosine to thymidine transition at nucleotide 2435 in exon 8, resulting in substitution of alanine 464 by valine (A464V). The fathers genotype thus was 7delG/A464V. Mutation A464V was not found in 18 unrelated MLD patients and 50 controls. A464V, although clearly modifying ARSA and GS levels, apparently bears little significance for clinical manifestation of MLD, mimicking the frequent ARSA pseudodeficiency allele. Our results demonstrate that in certain genetic conditions MLD-like ARSA and GS values need not be paralleled by clinical disease, a finding with serious diagnostic and prognostic implications. Moreover, further ARSA alleles functionally similar to A464V might exist which, together with 0-type mutations, may cause pathological ARSA and GS levels, but not clinical outbreak of the disease.

[Changes in arylsulphatase activity (EC 3.6.1) in the blood serum and urine in women during the pregnancy and in the course of delivery]

By the determination of arylsulphatase A activity (EC 3.1.6.1) in the blood serum and urine obtained from 66 women using the modified method by Lee-Vaupel and Conzelmann it was noticed the increase in the enzyme activity during the pregnancy comparing to the non-pregnant group. The highest enzyme activity was observed in the III trimester of pregnancy. In the following stages of delivery (I, II, III) it was assumed the increase in enzyme activity in urine. The highest enzyme activity in urine was observed in the stage III, and in the serum--in the stage II. It was compared the enzyme activity in primiparae and multiparae proving, that in the serum nd urine this activity is higher in the stages I and II in multiparae, and in the stage III in primiparae.

[The arylsulphatase A (EC 3.1.6.1) activity in serum, urine and amniotic fluid from pregnant women with EPH-gestosis]

In serum, urine and amniotic fluid obtained from the 52. women divided into three groups the arylsulphatase A (EC 3.1.6.1) activity was measured by the modified Lee-Vaupel and Conzelmann method. It was noticed in serum from the pregnant women with EPH-gestosis the statistically significant (p < 0.05) increase in the enzyme activity comparing to the results from non-pregnant women and pregnant with normal course of pregnancy. It was no statistically significant differences in the urine from pregnant with EPH-gestosis and from the healthy pregnant, but there was the increase (p < 0.01) in the enzyme activity in amniotic fluid from pregnant women with EPH-gestosis comparing to the physiological course of pregnancy. According to our data, the arylsulphatase A activity assay could be recommended as a diagnostic marker in the EPH-gestosis.

Practical suggestions in diagnosing metachromatic leukodystrophy in probands and in testing family members

Metachromatic leukodystrophy (MLD) is one of the most severe genetically determined demyelination diseases. It is caused by a deficit in the activity of sulfatide sulfatase. The diagnosis is made by demonstrating a deficiency of arylsulfatase A (ASA) activity in leukocytes or cultured skin fibroblasts. Diagnosis based only on the activity of ASA is complicated by the fact that there exists a condition of ASA pseudodeficiency (Pd). Due to the relatively high risk of the MLD/Pd and MLDPd/Pd genotypes among families of patients, it is possible to make an erroneous diagnosis on the basis of only ASA activity. Nonetheless, it seems necessary to develop a reliable and simple diagnostic procedure so as to enable diagnosis and genetic counseling for carriers. We present two diagnostic flow charts entailing determination of ASA activity, identification of the pseudodeficit mutation and detection of sulfatides in a 24-hour urine collection.

Metachromatic leukodystrophy in Greece: observations on 4 cases

We report our findings in four cases of metachromatic leukodystrophy diagnosed in Greece during the last 4 years. The age of onset and the clinical symptoms were those described for the late infantile form of the disease. However, one patient retained his speech and mental abilities despite his pronounced motor regression and neurological involvement. This was combined with high residual arylsulphatase A activity in white blood cell homogenates even in the 0 degrees C incubation assay.

Arylsulfatase A in urine of patients with urothelial tumors

A significant increase in urine arylsulfatase A activity (p less than 0.01) was found in patients with urothelial tumors. Arylsulfatase A activity was 1.36 +/- 1.10 U/24-h urine in control specimens, 1.90 +/- 1.66 U/24-h urine in various genitourinary tract disorders, and 3.90 +/- 1.98 U/24-h urine in transitional cell carcinoma specimens. Surgical treatment of the neoplastic patients lowered the arylsulfatase A activity found in urine to within reference values. The arylsulfatase A excreted by patients with these tumors was highly sensitive to thermal inactivation while the enzyme activity in the control urines was less affected by the heat treatment. The time course of the arylsulfatase A reaction with 4-nitrocatechol sulfate was not linear in normal individuals, while it was linear in 90% of patients with urothelial tumors. This difference in the kinetic pattern of the enzyme could be used to increase the diagnostic specificity of the determination.

The heterogeneity of arylsulphatase-A and arylsulphatase-B in normal human urine and urine from cancer patients

Arylsulphatase-A and arylsulphatase-B heterogeneity in normal and cancer patient urine was investigated using high resolution agarose isoelectricfocusing. Normal urine contained up to nine forms of arylsulphatase-A activity with isoelectric points from 4.45 to 5.43 and at least 5 forms of arylsulphatase-B between 8.58 and 9.15 along with a broad zone of activity between pH 6.5 and 7.6. Although cancer patients had significantly higher levels of arylsulphatase-A and arylsulphatase-B activity, their pattern of activity was essentially the same as for the normals with only minor quantitative differences in some peaks.

Pancreatitis and alcoholism disorder the renal tubule and impair reclamation of some low molecular weight proteins

We sought to determine whether the clinical setting in which pancreatitis occurs affects the incidence and distribution of increased values of renal clearance of amylase relative to creatinine, CAm/CCr, and whether the increased values reflect a tubular disorder that impairs renal reclamation of certain low molecular weight proteins. We measured the renal clearance of three low molecular weight proteins (amylase, beta 2-microglobulin, and lysozyme) and urinary excretion of three lysosomal enzymes that originate from the renal tubule in three groups of patients (alcoholic pancreatitis, pancreatitis without alcoholism, and alcoholism without pancreatitis). When compared to normal controls, the mean CAm/CCr was significantly elevated in alcoholic pancreatitis (p less than 0.05) but not in equally severe pancreatitis without alcoholism nor in alcoholism without pancreatitis. The clearance ratio of beta 2-microglobulin was significantly increased in each of the three patient groups; mean clearance ratio of lysozyme was not significantly increased in any of the patient groups. Excretion of each of the three lysosomal enzymes was significantly increased in each of the patient groups. We conclude that the etiology of pancreatitis affects the distribution of values for CAm/CCr, impaired tubular reclamation of amylase is the mechanism of the increase in CAm/CCr, and a factor or factors associated with both pancreatitis and with alcoholism per se appear to disorder the renal tubule and to impair tubular reclamation of some but not all low molecular weight proteins-a novel finding of considerable potential significance.

Phosphorylation and sulfation of arylsulfatase A accompanies biosynthesis of the enzyme in normal and carcinoma cell lines

Arylsulfatase A (arylsulfate sulfohydrolase, EC 3.1.6.1), a mammalian lysosomal enzyme, is initially synthesized as a 69, 67 and 64 kDa precursor polypeptide in a prostate carcinoma cell line PC-3SF12, in HeLa cells and in a normal human embryonic lung cell line WI-38, respectively. These precursor polypeptides are secreted into the medium or processed to mature enzymes of apparent molecular mass 66, 64 or 62 kDa in PC-3SF12, HeLa or WI-38 cells, respectively. The precursor and mature polypeptides in WI-38 cells are phosphorylated, and the phosphate is lost upon treatment with endo-beta-hexosaminidase H. Arylsulfatase A is also shown to be sulfated in WI-38 cells. The presence of castanospermine, an inhibitor of sulfation of the second N-acetylglucosamine residue of the chitobiose core, does not reduce the extent of sulfation of arylsulfatase A, suggesting that either terminal sugars or the protein is sulfated. Sulfation may have a protective function similar to that of terminal sialic acid residues in glycoproteins. Although the subcellular location of arylsulfatase A is identical in PC-3SF12 and in WI-38 cells, pulse-chase experiments indicate that arylsulfatase A protein has a slower turnover in the prostate carcinoma cell line than it does in the normal human lung cell line. The differences in the apparent molecular weights of arylsulfatase A in the normal and carcinoma cell lines are shown to be due to variations in the carbohydrate content of the enzyme. The apparent molecular mass of the polypeptide chain obtained after endo-beta-hexosaminidase H treatment is 59 kDa, a value which is identical for all three cell lines studied here. These results suggest the possibility of an enhanced activity of terminal glucosyltransferase enzymes in carcinoma cell lines and in tumor tissues. Arylsulfatase A may be a useful marker for studying transformation-related processes in human cell lines.

Radioimmunoassay for arylsulfatase A in urine

Purified arylsulfatase A (EC 3.1.6.1) from human urine was radioiodinated under conditions that caused no significant loss of antigenic activity. We used this labeled arylsulfatase A (specific radioactivity 4-7.5 Ci/g) together with nonlabeled enzyme and rabbit antiserum produced against homogeneous enzyme to develop a radioimmunoassay for arylsulfatase A in urine. A solid-phase, second-antibody technique (Immunobead Second Antibody; Bio-Rad Laboratories) was used to separate free enzyme from antigen-antibody complexes. The working range of the assay was 0.1-4.0 ng of enzyme; within- and between-assay CVs were around 10%, and the analytical recovery was 105.5% (SD 7.7%). The lower limit of detection was 0.08 ng of arysulfatase A per assay, substantially less than that of typical activity-based assays. Over a wide range of urinary arylsulfatase A activities, results by this method agreed well (r = 0.99) with those obtained by activity assays. We measured the enzyme in urines of 59 healthy volunteers and 92 patients with different diseases, including a group of colorectal cancer cases, to determine whether this could serve as a reliable marker for cancer of the colon; however, urinary excretion of arylsulfatase A by most patients with colon cancer was within normal limits.

Structural and immunochemical characterization of human urine arylsulfatase A purified by affinity chromatography

Arylsulfatase A (aryl-sulfate sulfohydrolase, EC 3.1.6.1) was isolated from an ammonium sulfate precipitate of urinary proteins using two different affinity chromatography methods. One method involved the use of concanavalin A-Sepharose affinity chromatography at an early stage of purification, followed by preparative polyacrylamide gel electrophoresis. The other procedure employed arylsulfatase subunit affinity chromatography as the main step and resulted in a remarkably efficient purification. The enzyme had a specific activity of 63 U/mg. The final preparation of arylsulfatase A was homogeneous on the basis of polyacrylamide gel electrophoresis at pH 7.5, and by immunochemical analysis. However, when an enzyme sample obtained by either method of purification was subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis under reducing or non-reducing conditions, peptide subunits, of 63.5 and 54.5 kDa, were observed. Immunological tests with 125I-labeled enzyme established the presence of a common protein component in both of the electrophoretically separable peptide subunits of human urine arylsulfatase. The amino acid analysis of homogeneous human urine arylsulfatase A showed only a few differences between it and the human liver enzyme. However, immunological cross-reactivity studies using rabbit anti-human urine arylsulfatase revealed immunological difference between the human urine and liver arylsulfatase A enzymes.

Prevalence of partial cerebroside sulfate sulfatase (arylsulfatase A) defect in adult psychiatric patients

Metachromatic leukodystrophy (MLD) is a disease caused by a deficiency of the enzyme sulfatide sulfatase, also known as arylsulfatase A (ASA). We compared the activity of this enzyme in adult psychiatric patients and normal volunteers using nitrocatechol sulfate (ASA-NCS) and cerebroside sulfate (ASA-CS) as substrates. Our results showed that ASA-NCS activity in urine and leukocytes was significantly lower in psychiatric than in normal individuals, but that there were no differences between these two groups in the sulfatide excretion in urine or the ASA-CS activity in leukocytes. There was no correlation between enzyme activity in urine and in leukocytes, indicating that activity in urine does not truly reflect the levels of the enzyme in tissues. The correlation between ASA-NCS and ASA-CS activity in leukocytes was poor (0.51 for psychiatric patients and 0.59 for normals), suggesting that for a valid measure of the enzyme activity the assays should be carried out with CS as substrate. Results of our study also indicate that in 39 of the 145 psychiatric patients studied, the ASA-CS activity in leukocyte was less than 4 nmoles/mg protein/hr, which is below 50% of the normal means, whereas only one of the 30 normal subjects had a value this low. The presence of low levels of ASA-CS activity in a significantly large number of adult patients with varying psychiatric manifestations suggests that such patients may be asymptomatic carriers of the sulfatidase defect (heterozygotes for MLD), and that behavioral and functional disturbances in these patients may at least in part be related to sulfatidase deficiency. The significance of the ASA-NCS abnormality (reduction) in psychiatric patients is unclear.

Arylsulfatase A activities in urine and tissues taken from bladder cancer patients

Urinary arylsulfatase A activity expressed as units/mg of urinary creatinine was significantly increased in bladder cancer patients, but not in patients with other genitourinary tract disorders, such as cystitis, urethritis and prostatic cancer, nor in patients with non-urological malignant diseases. The urinary enzyme activity was positively correlated with the stage of the bladder cancer, while post surgical follow-up revealed a marked decrease of the activity. Arylsulfatase A activity was also shown to be higher in malignant than in normal bladder tissue, demonstrating the activity to be a function of the grade of the tumor. Furthermore, the isoelectric point (pI 5.2-5.3) of the tissue enzyme in the bladder tumor coincided with that of the urine enzyme from the same cancer patients; the pI of the enzyme in urine from normal subjects was 4.7. These results suggest that most of the urinary arylsulfatase A in bladder cancer originates from tumor tissue.

Urinary glucuronidase and arylsulfatases in identical twins of bladder cancer patients

Studies showing that bladder cancer patients have unusually high levels of urinary beta-glucuronidase and arylsulfatases A and B led to the suggestion that these urinary enzymes may participate in bladder cancer etiology. An alternative explanation of the high levels of these urinary enzymes in bladder cancer patients is that the disease itself causes the elevation. Since the levels of these enzymes are genetically determined, measuring these enzymes in healthy identical twins of bladder cancer patients can test whether high enzyme levels occurred prior to bladder cancer. Five healthy identical cotwins of bladder cancer patients, together with matched controls, were measured for urinary beta-glucuronidase, arylsulfatases A and B, and two other lysosomal enzymes as controls, alpha- and beta-galactosidases. The mean levels of all five enzymes were not very different in the cotwins and controls, suggesting that high levels of urinary enzymes observed in bladder cancer patients are a consequence of disease rather than occurring prior to disease and contributing to its etiology.

[Methodological aspects of urinary enzymology]

Collection and storage of the sample exert significant influences on the results of urinary enzyme determinations. Enzymes with sufficient stability during urine collection and consecutive in vitro storage are probably best suited for diagnostic purposes. Sample preparation, e.g. by gel filtration of the urine should be performed to remove quantitatively interferences. Optimized methods for some urinary enzymes are now available offering a basis for standardization. Analytical results should be verified by the use of self-prepared or commercially available quality control materials. The modern clinical chemical technology permits the determination of enzyme activities in urine with a quality standard comparable to that in other body fluids. New approaches are the development of a dipstick test for beta-N-acetylglucosaminidase and the use of immunological techniques for the measurement of enzyme concentrations in urine.

Clinical significance of a variant form of urinary arylsulfatase A

A variant form of urinary arylsulfatase A which was not detected in normal voided urine was demonstrated in the urine obtained directly from the renal-pelvis [Ishibashi, T. et al.: Biochim. Biophys. Acta, 616, 218-227 (1980)]. The variant form was not observed in urine collected directly from the ureter during operations for uretero-cutaneostomy or ileal conduit. However, the urine from intubated uretero-cutaneostomy patients collected near the pelvi-ureteric junction showed the presence of the variant form, further suggesting the origin specificity of the variant. This arylsulfatase was not demonstrated in the voided urine from patients with non-urologic malignant disorders such as uterine endometrial, uterine cervical, rectal, pancreas head and gastric carcinomas, in spite of its appearance in high levels in the urine from patients with advanced bladder cancer.

Urinary arylsulfatase in normal children and in patients with pediatric malignant disease

Urinary arylsulfatase (AS) activities were measured in 20 normal children and 10 patients with malignant disease, consisting of leukemia (6), Hodgkin's disease (1), neuroblastoma (2), and malignant teratoma (1), Seven of the patients showed a significantly high activity, and a serial measurement carried out in 4 patients showed a well correlated relationship between AS activity and the activity of disease. Thus the measurement of urinary AS activity could be a laboratory test for monitoring the activity of malignant diseases because of its simple and rapid procedure.

A variant form of metachromatic leukodystrophy without arylsulfatase deficiency

The clinical, pathological, and biochemical findings in a young woman with a new variant of metachromatic leukodystrophy (MLD) are reported. The patient showed slow early development and deteriorated further during her first two decades. Nerve conductions were slow, and a sural nerve biopsy showed features of a sulfatide lipidosis. Urinary sulfatide excretion was comparable to that of patients with classic MLD, yet in vitro activity of arylsulfatase A and B and cerebroside sulfatase activity were normal. Skin fibroblasts cultured in medium supplemented with 3H-labeled sulfatide showed accumulation of labeled sulfatide in large amounts, implying a defect in sulfatide hydrolysis in vivo in spite of intact enzyme activity in vitro.

Aryl sulfatase A in acute nonlymphocytic leukemia

To ascertain whether estimation of urinary aryl sulfatase A (ASA) is a reliable noninvasive technique for monitoring disease activity in adult acute nonlymphocytic leukemia, we studied the excretion pattern of this enzyme during active disease, partial remission, and complete remission in ten patients and compared the results with those of ten healthy volunteers. There was no significant difference in enzyme excretion between complete remission cases and the control group. Patients with partial remission and active disease had significantly different urinary enzyme levels from each other and from the control and complete remission groups. Estimation of urinary ASA is a useful noninvasive method of monitoring disease activity in adult acute nonlymphocytic leukemia.

Presymptomatic diagnosis: metachromatic leukodystrophy or pseudo arylsulphatase A deficiency?

Diagnosis of metachromatic leukodystrophy (MLD) was established in the proband at age 27 months. An examination of the family arylsulphatase A profile revealed that the father and younger sibling, age 2 months, had very low enzyme activities like the proband. The father, in all likelihood, had the pseudo arylsulphatase A deficiency trait, but the sibling could be either pseudodeficient or affected with MLD. The fibroblast cerebroside sulphate loading test confirmed that the father had pseudo arylsulphatase A deficiency. The test also indicated that the sibling was affected with MLD. This was confirmed by clinical evidence of neurological degeneration by 18 months.

Some observations on the assay of arylsuphatase A in urine

A method for the measurement of arylsulphatase A (ASA) in urine is assessed. Urine samples should be stored refrigerated at 4 degrees C and not deep frozen prior to dialysis. The within-batch coefficient of variation of method, in the normal range, is 6.7%. The major source of imprecision is the dialysis step. The normal range is assessed and results are expressed as units per mole creatinine.

A variant form of arylsulfatase A in human urine derived directly from the renal pelvis: kinetic and immunological characterization

Arylsulfatase A (aryl-sulfate sulfohydrolase, EC 3.1.6.1) was examined in voided and in nephrostomic urine. A variant form of the enzyme was found in nephrostomic urine, in addition to the minor form, which is the sole component of arylsulfatase A in voided urine. The nephrostomic enzyme differed from the voided urine enzyme with respect to the kinetic parameters, the isoelectric point, heat stability and immunological reactivity. The isoelectric points of the voided urine and nephrostomic enzymes were 4.7 and 5.3, respectively. The nephrostomic enzyme was more heat-labile at 62.5 degrees C than the voided urine enzyme. Although the Km values of the two enzymes with nitrocatechol sulfate as substrate were almost the same, the V value of the nephrostomic enzyme was approx. one-hundredth that of the voided urine enzyme. The molecular weight (almost 130 000) did not differ between the voided urine and nephrostomic enzymes. It was demonstrated by various methods, using IgG antibody against the purified voided urine enzyme, that the nephrostomic enzyme was antigenically distinct from the voided urine enzyme.

Arylsulfatase A activity of urine in patients with various genitourinary tract disorders

Arylsulfatase A activity was measured in urine from patients with various genitourinary tract disorders such as bladder tumor and inflammation. No significant difference in enzyme activity was found between normal and affected urine on the basis of either the volume or protein content of urine, a finding which differed from previous results. However, it was demonstrated that urine from affected patients was more labile to heat treatment in comparison with the control. Upon pretreatment of urine arylsulfatase A at 62.5 degrees C for 10 min, an average of 57% of the original activity was lost in samples from patients with bladder tumor, 58% in those with testicular tumor and 62% in cystitis and urethritis, respectively, while the enzyme activity in the control urine lost only 27% with similar heat treatment. These results were statistically significant with p < 0.001. The arylsulfatase A from patients with advanced bladder tumors demonstrated the presence of a variant form (pI 5.3) which was not detected in normal urine. This variant of arylsulfatase A was also demonstrated in nephrostomy urine from patients with congenital obstruction of the pelvi-ureteric junction.

[Metachromatic leukodystrophy: report of 2 cases with histochemistry of nerves and muscles]

Two cases of metachromatic leukodystrophy, of the late infantile form are reported. The patients were a girl and a boy of 2 years 10 months old, with initial normal development, but by the age of 18 months began with gait disturbances, difficulty to speak and developed progressive mental deterioration, with signs of long tract involvement, absence of deep tendon reflexes, spasticity, blindness, muscle atrophy and finished in a vegetative state. The diagnosis was made electromyography (signs of denervation), motor nerve conduction velocity (very decreased), assay of arylsulfatase A in the urine (absence of activity), sural nerve biopsy (demyelination and presence of metachromatic granules by the cresyl-violet and toluidine blue) and muscle biopsy (atrophy of type I fibers and presence of metachromatic material in the intramuscular nerve fibers). A quick revision about diagnostic methods, transmission, pathogenesis and variant forms is made.

[Urinary excretion of arylsulfatases A and B in patients with renal transplants]

Arylsulfatase A and B activities have been determined in urine samples from four patients who received a Kidney allograft from living donors as a treatment for terminal uraemia. The values have been compared with those obtained in the urine of the respective donors. Two patients, with optimal renal functionality, the enzymatic activities were in the order of that observed in the urine of the donor in one case and lower than that of the donor in the other case. A patient showing kidney rejection episodes, reversed by the specific therapy, had the enzymatic activities higher than those shown by the donor. Another patient who suffered for two rejections, the last one irreversible, showed a constant higher value of the two enzymatic activities compared with those of the donor and a further increase during the rejection period. In the light of these preliminary results it seems that the determination of the arylsulfatase activities in the urine of transplanted subjects could contribute to establishing the functional activity of the transplanted kidney and also in establishing the tendency of the kidney to undergo rejection.

Fluorometric assay of the arylsulphatases in human urine

A method is described which differentiates arylsulphatase A and arylsulphatase B in human urine. 4-Methylumbelliferyl sulphate serves as the substrate, and silver ions are used to inhibit arylsulphatase A activity. Using fresh urine it is possible to obtain separate values for arylsulphatase A and B when both are present, thus providing a diagnostic test for metachromatic leucodystrophy.

A noninvasive technique for monitoring response to chemotherapy in human acute leukemia

To see whether urine enzyme activities could be used as an index in evaluating the disease status of leukemia patients, we examined the activities of four enzymes: arylsulfatases A(AS-A) and B(AS-B), alkaline phosphatase (AP), and lactate dehydrogenase (LDH). AP and LDH showed no consistent patterns. The activities of AS-A and AS-B correlated well with the patient's clinical status, increasing during progression of disease and decreasing toward normal activities during responses to therapy, as judged from bone marrow cellularity and differential. Among 23 untreated patients with a histologic diagnosis of acute leukemia we found increased activities of the urine enzymes in these proportions: AS-A in 23 patients (100%), AS-B in 22 (95.7%), AP in 7 (30.4%), and LDH in 10 (43.5%). Five patients in remission from acute leukemia had normal activities for all four enzymes. In one patient in remission for more than one year, a rise in urinary arylsulfatase activity preceded observable bone marrow relapse by 4 months. Unlike that of serum of urine lysozyme and serum copper, the determination of urine arylsulfatase activities appears to be a consistent, useful indicator of response to antileukemic therapy. In contrast to the determination of polyamines, the quantitation of arylsulfatase activity is achieved with greater ease and with instrumentation available in most clinical laboratories.

Urinary excretion of arylsulfatases in malnourished/vitamin A deficient children

Serum vitamin A (retinol) levels were generally low in all malnourished children (6-15 microgram/100 ml) compared with control children (50 microgram/100 ml). A significant increase in vitamin A after appropriate therapy was observed in all malnourished groups. Dietary supplements of proteins and calories even without extra vitamin A supplements increased serum vitamin A levels in cases of kwashiorkor indicating active mobilization of liver vitamin A. Total urinary arylsulfatase A activity excreted in 24-h or within 8-h in the morning (6 a.m. to 2 p.m.) was significantly reduced in cases of malnutrition with or without mild vitamin A deficiency symptoms. The excretion of arylsulfatase B was not altered. In cases of severe vitamin A deficiency coupled with malnutrition increased excretion of both arylsulfatases A and B was evident. These results on urinary arylsulfatases excretory pattern have been obtained either in samples collected for 24-h or specifically for 8-h (morning) and it is suggested that this test on urinary arylsulfatases may prove useful for detection of acute vitamin A deficiency with malnutrition in field studies. A ratio of arylsulfatases A/B of 2.0 or less seems to indicate mild malnutrition, the normal ratio being 3.4. Furthermore a low ratio coupled with increased excretion of both arylsulfatases A and B may be considered specific for acute vitamin A deficiency.

The activity of arylsulfatase A and B on tyrosine O-sulfates

L-Tyrosine O-sulfate was hydrolyzed by pure human arylsulfatase A (arylsufate sulfohydrolase, EC 3.1.6.1). The rate of hydrolysis was 1/20 of the rate with nitrocatechol sulfate, but was comparable to the rate with cerebroside sulfate. The reaction was optimal at pH 5.3--5.5 and displayed zero order kinetics with time and enzyme concentration. The Km was about 35 mM. The enzyme showed no stereospecificity and hydrolyzed D-tyrosine O-sulfate with Km and V similar to those for the L-isomer. Arylsulfatase B was less than 5% as effective as arylsulfatase A in catalyzing the hydrolysis of the tyrosine sulfates. The daily urinary excretion of tyrosine sulfate by a patient with metachromatic leukodystrophy (arylsulfatase A deficiency) was comparable to the excretion by control subjects. The biological relevance of the tyrosine sulfatase activity of arylsulfatase A remains uncertain.

Variation of arylsulphatase A: comparative studies of arylsulphatase A with synthetic and natural substrates in three families with metachromatic leucodystrophy

Arylsulphatase A activity was measured in leucocytes and cultured tibroblasts from individuals of three families with late infantile and adult metachromatic leucodystrophy, comparing enzyme assays with natural and two synthetic substrates including a simple and sensitive test employing 4-methylumbelliferly sulphate and AgNO3. Enzyme activities were compared with those obtained after isoelectric focusing. Arylsulphatase A values obtained for different heterozygotes were almost continuously scattered over the entire range from patient level to normal level. Nevertheless arylsulphatase A values of the heterozygotes were at least sligtly higher than the activity of diseases persons when measured with three different assays. The possibility is discussed of a crucial minimal level of residual arylsulphatase A activity necessary to avoid manifestation of the disease.

Monozygotic twins with presumed metachromatic leukodystrophy. Activity of arylsulfatase A in serum of patients and family

Arylsulfatase A (ASA) activity in urine and serum was assayed on two 21-month-old monozygotic twins with presumed metachromatic leukodystrophy (MLD), their parents, and kin. The patients showed a marked reduction in ASA activity in both urine and serum. The twins' parents and 11 kin, a total of 13 persons, were examined for ASA activity in serum, but it was not possible to delineate heterozygous carriers of MLD by the present study. The assay of ASA activity in serum promises to be useful for diagnosis of MLD.

Diurnal variations of urinary enzyme excretion

Variations in the urinary excretion of arylsulphatase A, beta-galactosidase, alpha-glucosidase and beta-glucuronidase throughout a 24-h period were studied in 8 healthy subjects. Urine was collected at 3-h intervals and enzyme activities were assayed after gelfiltration of the urine specimens. Significant intra-individual changes of the excretion of all 4 enzymes during the 24-h period were found. Enzyme output was high between 3 a.m. and 9 a.m. and low during the afternoon and evening hours. The most striking pattern was seen for arylsulphatase A. Diurnal variations of urinary enzyme excretion seemed not to be flow dependent. Both modes of expression of enzyme output (mU/min or U/g creatinine) gave corresponding results. It is concluded that for the measurement of the excretion of these enzymes urine should be collected during a fixed time interval, e.g. from 6 a.m. to 9 a.m.

Microheterogeneity of arylsulfatase A from human tissues

Human arylsulfatase A (cerebroside-3-sulfate 3-sulfohydrolase, EC 3.1.6.8) exhibited microheterogeneity on isoelectric focusing in polyacrylamide gels. Pure urinary enzyme gave 3 bands of activity with pI values of 4.7, 4.8 and 4.9, whereas purified liver enzyme yielded six equally spaced bands from pI 4.4 to 4.9. Detection of enzyme in the gel was made by either methylumbelliferyl sulfate or nitrocatechol sulfate. Crude enzyme preparations from human liver, kindey, placenta, brain and testis showed the six-banded pattern with varying amounts of activity in the different bands. The banding pattern of cultured human fibroblast extracts was distinctive: in addition to activity in the area of Bands 1-6 a sharp band at pI 5.1 was observed with both enzyme stains. This latter band was also present in metachromatic leukodystrophy fibroblast extracts. However, in this case the band did not appear when the specific aryl-sulfatase A stain was used. Enzyme Bands 1, 2 and 3 from urine were isolated by extraction of the gel. The three bands refocused in their initial positions; showed nearly identical enzymatic activities toward methylumbelliferyl sulfate, mitrocatechol sulfate, cerebroside sulfate and ascorbic acid 2-sulfate; and demonstrated equivalent immunological competence by antibody titration. The banding pattern of urinary arylsulfatase A was unchanged with neuraminidase treatment, whereas Bands 4-6 of the liver enzyme were converted to Bands 1-3 by this treatment. It appears that Bands 4-6 are due to sialylation of aryl-sulfatase A but that Bands 1-3 are probably due to some other type of post-ribosomal protein modification.

Normal limits of urinary excretion of eleven enzymes

Urinary excretion of lactate dehydrogenase, hydroxybutyrate dehydrogenase, gamma-glutamyltransferase, alkaline phosphatase, arylsulphatase A, alpha-glucosidase, beta-galactosidase, trehalase, N-acetyl-beta-glucosaminidase, beta-glucuronidase, and leucinearylamidase was studies in a carefully selected group of 100 healthy subjects, 50 women and 50 men. Enzyme activities were assayed in 3-h morning samples after gel filtration of the urine. Activities were related to time volume, and to urinary creatinine concentration. Several transforming functions had to be applied to enzyme output data to obtain an approximation to gaussian frequency distribution. Men showed a significantly higher excretion of gamma-glutamyltransferase, alpha-glucosidase, trehalase, N-acetyl-beta-glucosaminidase,beta-glucuronidase, and leucine arylamidase activity than did women if enzyme activity was related to urinary time volume. Women excreted more lactate dehydrogenase, hydroxybutyrate dehydrogenase, gamma-glutamyltransferase, alkaline phosphatase, alpha-glucosidase, trehalase, and N-acetyl-beta-glucosaminidase activity than did men, if urinary creatinine was used as the basis of reference. Reference intervals were calculated as 2.5 and 97.5 percentiles for both sexes.

Juvenile onset metachromatic leucodystrophy. Failure of response on a low vitamin A diet

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